On January 16, 2020, the Ministry of Health issued Decision No. 125/QD-BYT on guidelines for diagnosis and treatment of acute pneumonia caused by a new strain of Corona virus (nCoV).
According to the Ministry of Health, corona viruses (CoV) are a large family of viruses that cause illnesses ranging from the common cold to severe, life-threatening illnesses such as Severe Acute Respiratory Syndrome (SARS-CoV) in 2002. and Middle East Respiratory Syndrome (MERS-CoV) 2012. However, since December 2019, a new strain of corona virus (nCoV) causing pneumonia in Wuhan province (China) has been identified and has been reported. spread risk.
People infected with nCoV have acute symptoms such as cough, fever, difficulty breathing, which can progress to severe pneumonia, progressive acute respiratory failure and death, especially in people with chronic diseases, immunocompromised. .
There is currently no specific treatment and no vaccine to prevent the disease.
The Ministry of Health guides the diagnosis of acute pneumonia caused by a new strain of Corona virus:
Suspected cases include cases of fever and pneumonia, or interstitial pneumonia, or acute respiratory distress syndrome (ARDS) based on clinical or radiographic findings of lesions of various levels. varying degrees that cannot be explained by other infections or etiologies, including all cases clinically indicated for community-acquired pneumonia; and lived in or traveled to an area endemic for novel coronavirus within the 14 days prior to symptom onset, exposure (during the 14-day incubation period) to a case of fever and respiratory infection acute unexplained onset within 14 days of travel to an endemic area with novel coronavirus; fever and respiratory symptoms (cough, difficulty breathing...); and be present at health facilities in endemic areas with confirmed cases of healthcare-associated novel coronavirus; or have direct contact with sick livestock or wild animals in endemic areas within 14 days; fever or respiratory symptoms and onset within 14 days of exposure to a probable or confirmed case of nCoV.
Probable case when there is clinical and epidemiological evidence. Epidemiological evidence such as direct contact with a confirmed case by testing, including caregivers, health care workers or family members who live with the patient sick or visit sick people during illness symptoms. Clinical evidence such as the patient's clinical x-ray or histopathological findings of parenchymal lung disease (eg, pneumonia or ARDS) consistent with the case definition above; and was not confirmed by testing because the specimen could not be obtained or the test was not available to diagnose the cause of a respiratory infection; not explained by infection or other etiology.
Confirmed case is a case with clinical manifestations as mentioned above and tested positive for nCoV by Real time RT - PCR.
Differential diagnosis: pneumonia caused by nCoV should be differentiated from severe influenza (influenza A/H1N1 or avian influenza A/H5N1...); SARS-CoV and MER-COV; atypical pneumonia caused by other etiologies such as respiratory syncytial virus (SRV), adenovirus, mycoplasma,...
The subclinical test to identify nCoV is a Real time RT - PCR technique with respiratory tract fluid, sputum, and endotracheal fluid collected by cotton swabs and preserved in a suitable environment. Note that for the first cases of suspected new corona virus infection, units need to save samples and send samples to testing facilities authorized by the Ministry of Health for confirmation; the collection, preservation and transportation of medical specimens must comply with regulations; fully perform routine paraclinical tests for diagnosis, salary, and patient monitoring.
Principles of treatment: all suspected or possible cases must be examined in a separate area at the hospital, properly taken samples to do specific tests to diagnose the disease; confirmed cases requiring hospitalization for monitoring and complete isolation; Currently, there is no specific treatment drug, so it mainly treats symptoms, detects and promptly treats respiratory failure, kidney failure and other organs (if any).
Treatment of mild respiratory failure:
- Lying head high 30° - 45°
- Oxygen supply: When Sp0 < 92% or PaO25 65 mmHg or when there is difficulty in breathing (worked breathing, tachypnea, chest indrawing).
+ Oxygen through the nose: 1 - 5 liters/minute so that Sp0 > 92%.
+ Breathing oxygen through a simple mask: oxygen 6 - 12 liters / min when breathing oxygen through the nose can't keep SpO2 > 92%.
+ Oxygen through a mask with a reserve bag: the oxygen flow is high enough to not deflate the airbag during inspiration, when the mask simply is not effective.
Treatment of moderate respiratory failure:
- CPAP or High Flow Nasal Canula if available: Indicated when hypoxemia is not improved by oxygen measures, SpO2 < 92%. If possible, in children, CPAP should be indicated as soon as the nasal oxygen fails.
+ Target: SpO2 > 92% with FiO2 equal to or below
